Medicare Compliance & Reimbursement

Question: We have a client that we are providing home skilled nursing care for and we had sent the face to face encounter form to her provider. The form was returned to us with only the doctor’s signature, all other fields were left blank. We then refaxed it … and again it was returned the same way.

I placed a call to his office today and was told by a staffer that, “as of January 1, 2015 all providers are required to do, is to sign the form and it is the responsibility of the home health agency to fill in all fields of the form.” I told her that I will research this as we have never heard of this practice before and we will get back to her. We have reviewed all policies and cannot find this change anywhere. Do you have any insight on this or advice as to how to proceed?

Answer: Confusion over changes to the face-to-face (F2F) physician encounter rules for home health is straining the already frayed relationship between HHAs and their referral sources, and this is merely one example.

In this scenario, “the staff in the physician’s office is incorrect,” says Washington, D.C-based healthcare attorney Elizabeth Hogue.

For one, the  Centers for Medicare & Medicaid Services  (CMS) doesn’t require a F2F form, points out Mary Carr with the National Association for Home Care & Hospice. However, CMS is in the process of obtaining Office of Management and Budget approval for its voluntary F2F “Clinical Template,” a progress note that is supposed to help docs document the patient’s eligibility for home care services. HHAs have been frustrated with the form’s shortcomings, however.

Under the new F2F documentation rules that took effect Jan. 1, 2015, a physician’s own record must substantiate the patient’s home care eligibility — and agencies must obtain and then submit those records for medical review. But the physician can sign agency-furnished documentation into her own record, CMS has allowed. The physician still must have her own clinical note for the F2F encounter with certain elements specified.

Despite the new rules this year, many agencies have hung onto their old F2F forms, notes Chicago-based regulatory consultant Rebecca Friedman Zuber.

For agencies that do use a form, the new rules can make requirements murky. The “agency F2F request form is no longer required and does make physicians and others confused when mixed in with the current requirements,” observes clinical consultant Judy Adams with Adams Home Care Consulting in Asheville, N.C.

“HHAs can provide all or part of their assessment documentation and the physician can incorporate that as part of the F2F documentation by signing off on it and including it in the physician’s medical record,” Adams acknowledges. However, the physician must still document certain elements on her own.

And any form the agency asks the provider to fill out must be completed by the provider himself (or his staff). But agencies trying to show Medicare proof of this fact to referral sources have been stymied. HHAs “can’t find it because it’s just wrong,” Friedman Zuber emphasizes.

Thankfully, one Home Health & Hospice Medicare Administrator has now put that fact in writing. In an article posted Nov. 19 about the upcoming “Probe & Educate” medical review initiative, MAC Palmetto GBA says “If the agency is using a F2F form to send to the physician … the agency cannot complete the F2F form and simply submit that form to the physician for a signature and expect that to meet the requirement.”

“CMS has maintained that position from the beginning,”Carr tells Eli. “But I’m glad that at least one of the contractors has addressed the old F2F form.”